HomeMy WebLinkAboutNANCE 410 AMEND 2/02/17Statement of Organization
Recipient Committee
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Attach additional information on appropriately labeled continuation sheets.
penalty of perjury under the laws of the State
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01 the State of Cal lomia
FEB 0 61011
ELECTIONS
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DATE SIONPVREOFCONTROLIINGOPFrCEMOLDER CANDIWi ORSMEMV UREPROPONENT
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DATE EIONATUREOF CONTROTINO OFFICEHOLDER CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410I1an /2016)
FPPC Ativlce: aCNce@fppc.ca.gov(866 /2]5 -3]]2)
www.fPPc.ra.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
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• All COmmitteaa must list the financial Institution where die algn WMc account is toted.
F Of iINPH[MtIHS O1n1 pREACODEIPXOXF MNC pUWNi NUMBER
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• List the name of each controlling officeholder, candidate, or state measure proponent. If Candidate or officeholder controlled, also list the elective: office sought or held, and
district number, if any, and the year of the election.
• List the political parry with which each officeholder or candidate is affiliated or check "nonpartisan."
• If this committee acts jointly with another controlled committee, list the name and identification number of the other Controlled committee.
NAME OF rANDWATE /OFFICENOLDER/ETATE MEASURE PROPONENT ELECi1VE OFFICF12 HTOR HELD
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Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDmKToSI NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO, OR LIMA) CANDIDAATE(S)WFIOESOU6HTORHELDORMEASUREISI IURISOICTION
FPPC Form 410(Jan /2016)
FPPC AdVIce: adulce®fppc.ca.9w)966 /1]S -3112)
www.fPPuo.goa
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FPPC Form 410(Jan /2016)
FPPC AdVIce: adulce®fppc.ca.9w)966 /1]S -3112)
www.fPPuo.goa
Statement of Organization
Recipient Committee
INSTRUMONS ON REVEME
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® Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Commlttee 0 COUNTY Committee 0 STATE Committee
List additional sponsors on an attachment.
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• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no Intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the political Reform Act disclosing all reportable transactions.
— There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
— Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
IWC Form 430 (Jan/1016)
FPPC Advice: advin@fppc.ra.gov (6661173 -3771)
wwwfppc.w.gov